Reader Q+A: Is Tummy Time Mean or Cruel If My Baby Can't Hold Her Head Up Yet?

No doubt you’ve heard the recommendation that your baby should have daily Tummy Time. But like everything else in parenting, there are dissenting opinions on the topic that can leave new parents and pregnant parents-to-be confused.

Perhaps you’ve heard that Tummy Time is cruel or unfair because babies don’t have the strength to lift their heads yet. Let’s take a closer look at newborn development to see if this is true.

Is Tummy Time mean or cruel for a newborn. CanDo Kiddo

The Abilities Your Baby Is Born With

Babies arrive in the world hard-wired with a wide range of reflexes (often called primitive or infantile reflexes). Some of these equip your baby wonderfully for the belly-down position.

One of the most jaw-droppingly amazing demonstrations of the beauty and value of primitive reflexes is the "breast crawl." When placed on their tummies on mommies belly or chest immediately after birth, newborns can reflexively make crawling motions with their arms and legs to make their way to the breast. They can turn their head toward the breast, briefly lift their heads to see, find the nipple with their limited eyesight and reflexively root and suck to initiate nursing. 

See newborn reflexes in action in this video below (which obviously shows breasts, thankfully not mine):

In light of this set of reflexes and how well healthy, full-term newborns are able to use them, it becomes easier to see that Tummy Time is a natural position that the neonate is equipped for.

Babies Aren't Tiny Adults

It can be tempting to try to put ourselves in our baby’s shoes (or in her itty bitty, impossibly soft booties), but this isn’t helpful for understanding how our baby experiences the world around her. Sure, if I laid you face down on the floor and limited your ability to lift your head up, you’d probably be really angry and frustrated. This is an argument against Tummy Time that I've heard from several sources, but here are some important things to remember:

  • You can clearly see more than 8-10” from your face so you would want to lift your head to see more in the room around you. Remember that newborns can’t see what’s going on across the room yet. They can best see about the distance from their faces to their hands. 
  • As an adult you are used to being able to move your body however you choose, so having your movements limited would be frustrating. Newborns haven’t yet made the transition from reflexive movements to volitional or purposeful movements. They don't feel deprived of an ability to lift and hold their heads at midline because this isn't an ability they've developed yet.
  • You’ve got better things to attend to than what the ground feels like when you lay on it and what it feels like to put your hand to your mouth. You want to get up and do. A newborn lives right here, right now. Your little one is experiencing a completely new world at the most subtle levels. Every single sensation is a learning experience for her. This experiencing is one of the important occupations (or meaningful activities) of infancy.

Tummy Time Is About More Than Neck Strength

Yes, neck strength is one of the many important benefits of Tummy Time. But as I mention in Begin With A Blanket: Creative Play For Infants, most of a newborn’s early Tummy Time will be spent with her cheek down on the surface beneath her in the first weeks of life. So what's the point?! If you’ll indulge me in some infant development nerdiness, I'd love to share with you a bigger picture of what's happening when a newborn is placed on her tummy.

The Importance of Stretching

In motor development, muscles first elongate (or stretch) before they activate (or strengthen). A near full-term baby in the womb is most typically in the fetal position with chin tucked to chest, shortening the muscles on the front of the body and neck and elongating the muscles on the back of the body and neck.

Laying in Tummy Time with the cheek down helps stretch the front and side neck muscles that were shortened in the womb. These are the very same muscles that are most often tight in cases of Torticollis, resulting in a head tilt and turn to one side. Sure, attempts to briefly lift and turn the head in newborn Tummy Time help activate, or strengthen the muscles of the neck. But even time resting with cheek down provides important stretching that lays the foundation for your newborn baby to strengthen all of her neck muscles in the coming weeks and months.

Newborn babies are very top-heavy, so Tummy Time in the early days and weeks puts most of baby's weight on the upper torso and head. This not only provides elongation or stretch to the neck, but also to the chest muscles which tend to be tight from the fetal position. Stretching the chest muscles helps prepare your baby for later shoulder and shoulder blade strength and mobility, which are very important for the development of fine motor skills. 

The Value of Hand To Mouth and other hidden benefits of Tummy Time for newborns. CanDo Kiddo

The Benefits of Hand to Mouth

In the belly-down position, a newborn baby's hands are typically folded under or near her body with fisted hands up near her face. This affords lots of mouthing of the hands - extremely valuable for tactile (touch) sensory development of the hands and mouth as well as oral motor development and self-soothing. In other positions, newborns lack the motor control to efficiently and consistently bring their hands to their mouths. 

The Hidden Value Of Asymmetrical Head Lifting

The value of tummy time when baby can hardly lift her head. CanDo Kiddo

Most newborns cannot lift and hold their heads at midline (or in line with their bodies). Instead, when they do briefly lift their heads, they are able to look to one side and turn to look to the other side. You know the really cool thing that this does? It introduces the sensation of weight-shifting to your baby. With the head off-center, the weight of the body is off-center, too. Turning the head moves the weight and baby uses her proprioceptive sense (which I like to call the pressure & stretch sense) to learn from these sensations.

Why is weight-shifting important? It's essential for rolling, for balance, for sitting, standing, walking and just about every motor skill you can imagine. Isn't it amazing how something SO SUBTLE that you didn't even know your baby is doing is laying the groundwork for all of their later movements?!   Here's a six-day-old baby girl doing a great job demonstrating weight shifting (and newborn reflexes) in Tummy Time:

Delaying Tummy Time Isn't Helpful

For healthy, pre-term infants Tummy Time should begin in the first week of life, preferably the first day. This doesn't mean you have to put a blanket on the hospital floor and leave your baby to play alone. Letting baby lay on your chest as you lay back, lay across your lap, or be carried football-style on your forearm are great ways to start Tummy Time from day one.

It's tempting to think that waiting to start Tummy Time until baby is a bit older and stronger will help improve her tolerance for the belly-down position. I propose that quite often, the opposite is true. If you wait to introduce Tummy Time:

  • Infant reflexes have begun to integrate (or disappear) and are diminished, so baby isn't as equipped to tolerate the belly-down position.
  • Baby's vision and awareness of the environment will have improved, leaving her more interested in looking around and more frustrated by her inability to do so.
  • Baby will have begun to develop volitional or intentional movements and may be frustrated by the strength challenges of this position.
  • Especially for babies who spend lots of time supported by Baby Holding Devices (car seat carriers, infant swings, bouncy seats, etc.) in a flexed position similar to the fetal position, lingering tightness of the neck and chest muscles may make Tummy Time more difficult and less comfortable. Learn more about Baby Holding Devices and how they affect development.

Some Babies Do Dislike Tummy Time

Starting Tummy Time in the first days of life certainly isn't a guarantee that your baby won't be one of those who dislikes Tummy Time. But I do think that it improves the chances of your baby tolerating the position. It's important to note that in the breast crawl video above, you hear the baby making little grunting and squawking noises (I like to call them baby bird noises). It's important to differentiate those from actual crying. Allowing your baby to "work" in Tummy Time for brief periods is different from leaving your baby in face-down misery. Here are some tips for making Tummy Time more tolerable for your little one. 

To Wrap Up...

As parents, all we can do is wade through the conflicting opinions and advice and find what rings true and sounds wise to us. As a therapist, all I can do is add information to the Tummy Time discussion that is representative of the body of knowledge of my profession. I can present my perspective through the paradigm of my field of practice. And I respectfully agree to disagree with those who have an alternative view of or limited understanding of infant development and the value of Tummy Time. Read what other therapists are saying about Tummy Time on this blog hop hosted by Golden Reflections Blog.

My hope is always to give you more information so that you can make the decisions that are right for your child and your family AND to help you better understand your kiddo's development so that you can have more moments of marveling at how amazing it is!

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